Anemia 1

Iron Deficiency Anemia

Elisabeth A. Fandrich

Montana Tech, Nursing Department

NURS 1566 Core Concepts of Adult Nursing

Noel Mathis RN, BSN, MSN

May 2, 2008

Iron Deficiency Anemia

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Anemia is the condition of having too few circulating red blood cells or components of

the red blood cells. Red blood cells usually make up 40-45% of the total blood volume. This

percentage is called hematocrit. The most important function of red blood cells is to carry

oxygen from the lungs to the tissues of the body. Hemoglobin is a molecule contained within

red blood cells. Each molecule of hemoglobin contains iron which binds with oxygen in areas of

high oxygen concentration (the lungs), and releases oxygen in areas of low oxygen concentration

(the capillaries). This iron contained within the hemoglobin is what gives blood its red color.

Hemoglobin also helps remove carbon dioxide from the body. An enzyme called carbonic

anhydrase is contained within the hemoglobin. This enzyme is the catalyst which speeds up the

molecular breakdown of carbon dioxide into hydrogen ions and bicarbonate ions. The hydrogen

ions bind with the hemoglobin, and the bicarbonate ions enter the blood plasma. The majority of

carbon dioxide is removed through the blood in this way. The remaining amount of carbon

dioxide is carried intact by the hemoglobin to the lungs where it is expelled from the body.

Anemias are classified in two ways. The first is by size and hemoglobin content of the

red blood cells. The second is by mechanism or cause. Iron deficiency anemia is classified as

microcytic hypochromic. To further classify iron deficiency anemia, the cause must be known.

There are several potential causes of iron deficiency anemia. The most obvious reason

for being iron deficient is inadequate dietary intake of iron. Other reasons are poor absorption of

iron by the body, blood loss (including heavy menstrual bleeding and gastrointestinal bleeding)

and loss of iron through the urine (hemosiderinuria, hemoglobinuria, and pulmonary

hemosiderosis). This type of anemia is also associated with use of aspirin and NSAIDs, celiac

disease, lead poisoning, and certain types of cancers. At the time I assessed 3512,W,E, the cause

of her anemia was unknown. Gastrointestinal bleeding was suspected in this patient after a

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hemooccult stool sample came back positive for blood. A diagnostic procedure was planned, but

I was unable to obtain the results.

Common symptoms of iron deficiency anemia include pallor, fatigue, irritability,

weakness, shortness of breath, brittle nails, pain of the tongue, pica, frontal headache, anorexia,

and bluish sclerae. If the condition is mild, the patient may be asymptomatic. 3512,W,E

presented to the emergency department at 2330 April 27, 2008 complaining of abrupt onset of

“heartburn”, substernal chest pressure and headache. She described that it came on at

approximately 2030 that evening. It persisted until arrival at the emergency department. She

described the pain and pressure as moderate intensity and that it did not radiate. There was

associated nausea, shortness of breath and diaphoresis. She denied vomiting.

A complete assessment including history and physical along with laboratory studies of

blood, stool and urine are used to diagnose this condition. Common lab studies ordered are

CBC, peripheral smear, serum iron, total iron-binding capacity (TIBC), serum ferritin, MCV,

MCHC, stool occult blood, testing for hemoglobin in the urine without the presence of red blood

cells and hemoglobin electrophoresis. Other procedures used diagnostically are bone marrow

aspiration and measurements of tissue lead concentrations. Pertinent lab results for 3512,W,E

were as follows on admission: WBC 11.63 ↑ (normal:3.5-10 K/uL ), RBC 4.13 ↓ (normal: 4.2-

5.40 M/uL), Hgb 10.5 ↓ (normal: women 12-16 g/100 mL), Hct 31.5 ↓ (normal: women 36-

46%), serum glucose 170 ↑ (normal: 65-110), CK 253 ↑ (normal: 22-235 u/L), CKMB 1.6

normal (normal: 0-6 ng/mL), Toponin I <0.02 normal (normal: 0.0-0.40 ng/mL), MCV 76.3 ↓

(normal: 82-98 fl), MCH 25.5 ↓ (normal: 27.0-33.0 pg), MCHC 33.4 normal (normal: 32.0-36.0

gm/dL), and RDW 16.6 ↑ (normal: 11.5-14.5%). Further tests were ordered the next day after

the results of the initial lab tests were known. Stool occult blood tested positive (normal:

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negative), ionized calcium 4.49 ↓ (normal: 4.75-5.63 mg/dL), serum iron 13 ↓ (normal: 25-165

uf/dL), ferritin 5 ↓ (normal: 10-120 ng/mL), total iron-binding capacity 366 normal (normal:

250-450 ug/mL), and reticulocyte count 1.5 normal (normal: 0.5-1.5% of all RBCs). A

definitive diagnosis was not made before I reported to the nurse at the end of my shift.

However, the lab tests indicate that the chest pain and pressure was not related to a heart attack

as was initially suspected, but rather, it was a symptom of iron deficiency anemia related to loss

of blood in the gastrointestinal tract.

Treatment of iron deficiency anemia varies with the cause of the anemia. Underlying

etiology should be resolved to prevent future episodes of iron deficiency anemia. Because most

patients with iron deficiency anemia have a lack of iron in the diet, supplements and food

recommendations (iron fortified foods, red meats, green leafy vegetables) are all that is needed.

If the cause of the anemia is hemorrhage, surgery may be indicated. Activity restrictions may be

indicated until the deficiency resolves with the use of oral iron supplements. If the anemia

3512,W,E is experiencing is discovered to be caused by hemorrhage in the gastrointestinal tract,

surgery may be indicated to repair the damage. Medications and other treatments associated

with abdominal surgery would apply.

Patients taking oral iron supplements should be advised to take the medication as

ordered, to follow a diet high in iron, and take the medication on an empty stomach unless

gastrointestinal upset occurs. Patients should also be informed that oral iron supplements may

cause their stools to become black or dark green and “tarry”. This change is harmless and

expected. Patients taking liquid forms of iron supplementation should be advised to mix the

liquid with a beverage (preferably high in vitamin C, not milk), and consumed via a straw to

prevent discoloration of the teeth.

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3512,W,E is a 38 year old female who is obese, has a history of diabetes, hypertension,

hypercholesterolemia, previous heart attack and TIA. This patient has a history of illicit drug

use which ceased in 2004. The prognosis for this patient depends greatly on her commitment to

make lifestyle changes in order to improve her general well-being. The iron deficiency anemia

may be corrected with surgery or supplementation. The patient’s weight, diabetes mellitus,

hypertension and hypercholesterolemia are concerning, especially considering her history of

heart attack and TIA at a relatively young age. It is difficult to determine a specific prognosis

regarding the iron deficiency anemia, as it’s cause and treatments are currently unknown.

References

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(2008, January 30). Iron-Deficiency Anemia. Retrieved April 29, 2008, from University of Maryland Medical

Center

Web site: http://www.umm.edu/blood/aneiron.htm

Bianco MD, C. (2007). How Blood Works. Retrieved April 29, 2008, from Howstuffworks Web site:

http://health.howstuffworks.com/blood1.htm

(2007). Anemia Classification. Retrieved April 29, 2008, from University of Texas at Brownsville Web site:

http://blue.utb.edu/medlabtech/hematology%201415/anemia5.html

Conrad MD, BS, Marcel E. (2006). Iron Deficiency Anemia. In eMedicine [Web]. New York, NY: WebMD.

Retrieved April 29, 2008, from http://www.emedicine.com/med/TOPIC1188.HTM#section~AuthorsandEditors